How to prove a caregiver visit happened

A hundred and fifty-five dates of service, and no one was home

On 28 May 2026 the Missouri Attorney General’s office announced seven Medicaid fraud convictions. In the lead case, the owner of a home-care company submitted electronic visit verification records for personal-care services to three clients who had already died and to one who was in hospital during the window the visits were claimed for. The records covered 155 dates of service between November 2021 and August 2022. Medicaid paid $5,125 against them. The court ordered $13,129 in restitution, damages and penalties.

The number that matters in that paragraph is not the money. It is 155. Every one of those dates had a visit record. The system did what it was built to do, on schedule, for fifteen months, and the visits were not happening.

Hold that at the right size. One conviction is an anecdote, not a rate, and nobody publishes a credible number for how often a home-care visit gets wrongly disputed: the arguments settled by a phone call leave nothing behind to count, and the ones reaching an indictment are the rare tail. Treat any vendor quoting you a percentage accordingly. Where a case like this earns its keep is the mechanism, and the mechanism is blunt. An entry asserting that a visit happened is worth whatever the entry process behind it is worth.

What the law asks a visit record to verify

Electronic visit verification is not a vendor idea. Section 12006 of the 21st Century Cures Act made it a condition on federal Medicaid money, and the definition now sits in the statute at 42 U.S.C. § 1396b(l): a system under which visits are electronically verified with respect to the type of service performed, the individual receiving the service, the date, the location of service delivery, the individual providing the service, and the time the service begins and ends. A state that does not require one for personal care services takes a federal matching-rate reduction, stepping up to a full percentage point from 2023. Home health care services came under the same requirement from January 2023, on a schedule of their own that reaches a full point in 2027.

Six elements. Read them again and notice what the statute is quiet about: how any of them get established. That was left to the states and the systems they bought, which is why EVV in one state is a call placed from the client’s landline and in another is a phone app taking a location reading. It also explains the shape of the Missouri file. Records existed for every one of those 155 dates, and they were submitted by the party being paid for the visits.

A dispute asks two questions, and the file answers them differently

When someone contests a visit, they are contesting one of two things, and running them together is how a review turns into an argument about feelings. Was anybody there. And was the work done. A check-in reaches for the first. A visit note reaches for the second, and reaches for it in prose, written up afterwards from memory or from last week’s template.

Who is asking tells you which one they mean. A son calling from another state is asking whether his father sat alone from nine until eleven on Tuesday. A payer working through fifteen months wants both answers, per date, in a form it can sample. And an aide told she skipped a round she knows she walked will take whichever answer is available, and generally finds that neither is.

What can still be shown once the argument has started

If a dispute is already open, the useful work is narrow and it is mostly not documentation. The visits are past. What remains is assembling what exists and not damaging it.

• Pin the dates. “She was barely there in March” is not a question anybody can answer. A list of contested dates is, and it usually turns out to be shorter than the complaint sounded.
• Look for anything your agency did not write. A parcel signed for at the door, a pharmacy delivery, a doorbell clip the family kept, a text sent from the house, the client’s own account where they can give one. Each is thin on its own. Together they are the only part of the file that did not come from you.
• Freeze the notes. Nothing gets cleaned up, filled in or reformatted after a complaint arrives. A tidied file reads worse than an untidy one, and the tidying is usually the part that gets asked about.
• Answer with dates, not adjectives. A reply describing your quality standards invites a reply about their experience. A reply listing what the record holds for 9 March invites a check.

The photographs you already have, and why they still argue

Very few agencies are short of pictures. Aides send them constantly: a meal on the table, a filled organiser, a note left out for the next shift. They arrive by text or in a group chat, usually because a coordinator once asked for them, and they accumulate for years. When a visit is questioned, somebody scrolls back through that thread hunting for the right Tuesday.

Three things go wrong there, and none of them is about anyone’s honesty. Retrieval is the first: a thread is ordered by when a message was sent, not by client or shift, so finding 9 March depends on someone remembering 9 March. Authorship is the second, and it is the same problem the timesheet has. The picture arrived from the phone of the person whose attendance is being questioned, at a moment of that person’s choosing, and the date travelling with the file is a property of the file.

The third is the one agencies discover late. A chat thread is a conversation, not a record. It carries scheduling changes, apologies, a coordinator’s private opinion of a difficult family, and complaints about other clients. Handing it to a payer or a lawyer as evidence of one visit hands over all of that too, which is why the thread that felt like documentation on Monday tends to get described as a liability by Friday.

Move one field off the phone that took the picture

Everything above is salvage. What changes the next dispute is one field, and it is the smallest one on the record: the clock.

Take a visit capture apart and ask who supplies each field. The caregiver supplies the photograph, and supplies it live: the link opens a viewfinder with no gallery sitting behind it, so a picture of a made bed from three weeks ago has nowhere to enter from. She supplies the location as well, when she chooses to share it, and where a client’s situation warrants it an agency can insist a reading be present before a submission is accepted at all. The time is the field she does not supply. Our server writes that one as the submission lands, for the unglamorous reason that a handset clock belongs to whoever is holding the handset. Those fields, together with the file’s storage path, run through SHA-256 as a set, and the resulting digest stops agreeing the moment any of them is edited. Detection is the honest word for that, not prevention. An altered record remains possible; it simply announces itself.

She installs nothing, which in home care is not a small detail. No app, no account, no onboarding session: a text lands on the phone in her pocket and the link opens in the browser. Nothing installed also means nothing that can follow her. Location is captured only at the moment of the photo. Never in the background. Never between jobs. We verify the work, not the worker’s whereabouts — and in practice, aides who did the round are the ones keenest for a record of it to exist.

Scheduling changes one more thing. On a visit your office dispatched, the entry is already open on our server before she taps anything, and her photo files into that entry instead of arriving loose. What a coordinator reviews the next morning is not a picture somebody chose to send in; it is a picture that landed inside a visit the office opened. Work nobody scheduled is kept apart on purpose: a caregiver can hold a standing personal link for unprompted captures, and those records carry an employee-initiated mark, which is how a Saturday callback stays out of the Tuesday round’s compliance count.

The claim worth making, and the one that ruins it

Two things hold up. A person stood in the room the photograph shows and made it through a lens, rather than lifting it out of a folder later. And the version you open in November is the version that was sealed in March.

Everything past those two is where an agency loses the argument it had just won. A made bed establishes nothing about whether the bath happened, whether the medication reminder was given, or whether two billed hours held two hours of care. Those remain judgements about care, and they belong to whoever supervises care. What genuinely moves is narrower: the conversation stops being about whether anyone can produce anything and starts being about what the thing produced shows. Running the same habit before a complaint arrives is how to verify a caregiver showed up; the contractor and vendor version of the argument is dispute-ready vendor records.

One practical constraint: whoever doubts the visit is almost never in the office, so the record has to reach them. A LockProof proof link renders in any browser with nobody signing in, which is what puts it in front of a daughter, an auditor or a nurse manager. It is deliberately short-lived: it expires seven days after it is minted, and a replacement is quick to issue without touching the sealed record beneath it. There is a finished one to look through at the sample proof record, while the agency-side view sits on LockProof for home care.

Which is the uncomfortable lesson in the Missouri file. That agency was not short of documentation. It had a record for every one of the 155 dates, filed on time, in the required system. Documentation was never the thing it was missing.